Dumping

Syndrome

National Digestive Diseases Information Clearinghouse

What is dumping syndrome?

Dumping syndrome occurs when food,
especially sugar, moves too fast from Mouth
the stomach to the duodenum—the first Esophagus
part of the small intestine—in the upper
gastrointestinal (GI) tract. This condition is
Stomach
also called rapid gastric emptying. Dumping
syndrome has two forms, based on when Liver
symptoms occur:
• early dumping syndrome—occurs

10 to 30 minutes after a meal

Duodenum Pancreas

• late dumping syndrome—occurs

2 to 3 hours after a meal

What is the GI tract?
The GI tract is a series of hollow organs
joined in a long, twisting tube from the
mouth to the anus—the opening where stool
leaves the body. The body digests food using
the movement of muscles in the GI tract,
along with the release of hormones and
enzymes. The upper GI tract includes the
mouth, esophagus, stomach, duodenum, and
small intestine. The esophagus carries food
and liquids from the mouth to the stomach.
The stomach slowly pumps the food and
liquids into the intestine, which then absorbs
needed nutrients. Two digestive organs, the
liver and the pancreas, produce digestive
juices that reach the small intestine through
small tubes called ducts.
Colon
Small Large
intestine intestine
Anus Rectum
The upper GI tract includes the mouth, esophagus,
stomach, duodenum, and small intestine. The
lower GI tract consists of the large intestine—which
includes the colon and rectum—and anus.
The last part of the GI tract—called the
lower GI tract—consists of the large intestine
and anus. The large intestine is about 5 feet
long in adults and absorbs water and any
remaining nutrients from partially digested
food passed from the small intestine. The
large intestine then changes waste from
liquid to a solid matter called stool. Stool
passes from the colon to the rectum. The
rectum is located between the last part of
the colon—called the sigmoid colon—and
the anus. The rectum stores stool prior
to a bowel movement. During a bowel
movement, stool moves from the rectum to
the anus.
What causes dumping
syndrome?
Dumping syndrome is caused by problems
with the storage of food particles in the
stomach and emptying of particles into
the duodenum. Early dumping syndrome
results from rapid movement of fluid into
the intestine following a sudden addition of
a large amount of food from the stomach.
Late dumping syndrome results from rapid
movement of sugar into the intestine, which
raises the body’s blood glucose level and
causes the pancreas to increase its release
of the hormone insulin. The increased
release of insulin causes a rapid drop in
blood glucose levels, a condition known as
hypoglycemia, or low blood sugar.
2 Dumping Syndrome
Who is more likely to
develop dumping syndrome?
People who have had surgery to remove
or bypass a significant part of the stomach
are more likely to develop dumping
syndrome. Some types of gastric surgery,
such as bariatric surgery, reduce the size of
the stomach. As a result, dietary nutrients
pass quickly into the small intestine. Other
conditions that impair how the stomach
stores and empties itself of food, such as
nerve damage caused by esophageal surgery,
can also cause dumping syndrome.
What are the symptoms of
dumping syndrome?
The symptoms of early and late dumping
syndrome are different and vary from
person to person. Early dumping syndrome
symptoms may include
• nausea
• vomiting
• abdominal pain and cramping
• diarrhea
• feeling uncomfortably full or bloated
after a meal
• sweating
• weakness
• dizziness
• flushing, or blushing of the face or skin
• rapid or irregular heartbeat
The symptoms of late dumping syndrome
may include
• hypoglycemia
• sweating
• weakness
• rapid or irregular heartbeat
• flushing
• dizziness
About 75 percent of people with dumping
syndrome report symptoms of early dumping
syndrome and about 25 percent report
symptoms of late dumping syndrome. Some
people have symptoms of both types of
dumping syndrome.1
How is dumping syndrome
diagnosed?
A health care provider will diagnose
dumping syndrome primarily on the basis
of symptoms. A scoring system helps
differentiate dumping syndrome from other
GI problems. The scoring system assigns
points to each symptom and the total points
result in a score. A person with a score
above 7 likely has dumping syndrome.
The following tests may confirm dumping
syndrome and exclude other conditions with
similar symptoms:
• A modified oral glucose tolerance test
checks how well insulin works with
tissues to absorb glucose. A health care
provider performs the test during an
office visit or in a commercial facility
and sends the blood samples to a lab for
1Glasgow RE, Mulvihill SJ. Surgery for peptic ulcer
disease and postgastrectomy syndromes. In: Yamada
T, ed. Textbook of Gastroenterology. Vol. 1. West
Sussex, UK: Wiley-Blackwell; 2009: 1060–1062.
3 Dumping Syndrome
analysis. The person should fast—eat or
drink nothing except water—for at least
8 hours before the test. The health care
provider will measure blood glucose
concentration, hematocrit—the amount
of red blood cells in the blood—pulse
rate, and blood pressure before the test
begins. After the initial measurements,
the person drinks a glucose solution.
The health care provider repeats the
initial measurements immediately
and at 30-minute intervals for up to
180 minutes. A health care provider
often confirms dumping syndrome in
people with
– low blood sugar between 120 and
180 minutes after drinking the
solution
– an increase in hematocrit of more
than 3 percent at 30 minutes
– a rise in pulse rate of more than
10 beats per minute after 30 minutes
• A gastric emptying scintigraphy test
involves eating a bland meal—such
as eggs or an egg substitute—that
contains a small amount of radioactive
material. A specially trained technician
performs this test in a radiology center
or hospital, and a radiologist—a doctor
who specializes in medical imaging—
interprets the results. Anesthesia is
not needed. An external camera scans
the abdomen to locate the radioactive
material. The radiologist measures the
rate of gastric emptying at 1, 2, 3, and
4 hours after the meal. The test can
help confirm a diagnosis of dumping
syndrome.
The health care provider may also examine • An upper GI series examines the small
the structure of the esophagus, stomach, and intestine. An x-ray technician performs
upper small intestine with the following tests: the test at a hospital or an outpatient
center and a radiologist interprets the
• An upper GI endoscopy involves
images. Anesthesia is not needed. No
using an endoscope—a small, flexible
eating or drinking is allowed before the
tube with a light—to see the upper
procedure, as directed by the health
GI tract. A gastroenterologist—a
care staff. During the procedure, the
doctor who specializes in digestive
person will stand or sit in front of an
diseases—performs the test at a
x-ray machine and drink barium, a
hospital or an outpatient center. The
chalky liquid. Barium coats the small
gastroenterologist carefully feeds the
intestine, making signs of a blockage or
endoscope down the esophagus and into
other complications of gastric surgery
the stomach and duodenum. A small
show up more clearly on x rays.
camera mounted on the endoscope
transmits a video image to a monitor, A person may experience bloating and
allowing close examination of the nausea for a short time after the test. For
intestinal lining. A person may receive several days afterward, barium liquid in
general anesthesia or a liquid anesthetic the GI tract causes white or light-colored
that is gargled or sprayed on the back stools. A health care provider will give the
of the throat. If the person receives person specific instructions about eating and
general anesthesia, a health care drinking after the test.
provider will place an intravenous (IV)
needle in a vein in the arm. The
test may show ulcers, swelling of the
stomach lining, or cancer.

4 Dumping Syndrome
How is dumping syndrome
treated?
Treatment for dumping syndrome includes
changes in eating, diet, and nutrition;
medication; and, in some cases, surgery.
Many people with dumping syndrome have
mild symptoms that improve over time with
simple dietary changes.
Eating, Diet, and Nutrition
The first step to minimizing symptoms of
dumping syndrome involves changes in
eating, diet, and nutrition, and may include
• eating five or six small meals a day
perform the injections. A health care
instead of three larger meals
provider injects the long-acting formula into
• delaying liquid intake until at least
Medication
A health care provider may prescribe
octreotide acetate (Sandostatin) to treat
dumping syndrome symptoms. The
medication works by slowing gastric
emptying and inhibiting the release of
insulin and other GI hormones. Octreotide
comes in short- and long-acting formulas.
The short-acting formula is injected
subcutaneously—under the skin—or
intravenously—into a vein—two to four
times a day. A health care provider may
perform the injections or may train the
patient or patient’s friend or relative to
the buttocks muscles once every 4 weeks.

Complications of octreotide treatment

30 minutes after a meal

include increased or decreased blood glucose

• increasing intake of protein, fiber, levels, pain at the injection site, gallstones,
and complex carbohydrates—found in and fatty, foul-smelling stools.
starchy foods such as oatmeal and rice
Surgery
• avoiding simple sugars such as table
sugar, which can be found in candy, A person may need surgery if dumping
syrup, sodas, and juice beverages syndrome is caused by previous gastric
surgery or if the condition is not responsive
• increasing the thickness of food by
to other treatments. For most people, the
adding pectin or guar gum—plant
type of surgery depends on the type of gastric
extracts used as thickening agents
surgery performed previously. However,
Some people find that lying down for surgery to correct dumping syndrome often
30 minutes after meals also helps reduce has unsuccessful results.
symptoms.

5 Dumping Syndrome
 Points to Remember
• Dumping syndrome occurs when food,
especially sugar, moves too fast from
the stomach to the duodenum—the
first part of the small intestine—in the
upper gastrointestinal (GI) tract.
• Dumping syndrome has two forms,
based on when symptoms occur:
– early dumping syndrome—occurs
10 to 30 minutes after a meal
– late dumping syndrome—occurs
2 to 3 hours after a meal
• People who have had surgery to
remove or bypass a significant part of
the stomach are more likely to develop
dumping syndrome. Other conditions
that impair how the stomach stores
and empties itself of food, such as
nerve damage caused by esophageal
surgery, can also cause dumping
syndrome.
• Early dumping syndrome symptoms
include
– nausea
– vomiting
6 Dumping Syndrome
– abdominal pain and cramping
– diarrhea
– feeling uncomfortably full or
bloated after a meal
– sweating
– weakness
– dizziness
– flushing, or blushing of the face or
skin
– rapid or irregular heartbeat
• The symptoms of late dumping
syndrome include
– hypoglycemia
– sweating
– weakness
– rapid or irregular heartbeat
– flushing
– dizziness
• Treatment for dumping syndrome
includes changes in eating, diet,
and nutrition; medication; and, in
some cases, surgery. Many people
with dumping syndrome have mild
symptoms that improve over time with
simple dietary changes.
Hope through Research
The National Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK)
conducts and supports basic and clinical
research into many digestive disorders,
including dumping syndrome.
Clinical trials are research studies involving
people. Clinical trials look at safe and
effective new ways to prevent, detect, or
treat disease. Researchers also use clinical
trials to look at other aspects of care, such
as improving the quality of life for people
with chronic illnesses. To learn more about
clinical trials, why they matter, and how to
participate, visit the NIH Clinical Research
Trials and You website at www.nih.gov/health/
clinicaltrials. For information about current
studies, visit www.ClinicalTrials.gov.
For More Information
American College of Gastroenterology
6400 Goldsboro Road, Suite 200
Bethesda, MD 20817
Phone: 301–263–9000
Fax: 301–263–9025
Email: info@acg.gi.org
Internet: www.gi.org
American Gastroenterological Association
4930 Del Ray Avenue
Bethesda, MD 20814
Phone: 301–654–2055
Fax: 301–654–5920
Email: member@gastro.org
Internet: www.gastro.org
American Neurogastroenterology and
Motility Society
45685 Harmony Lane
Belleville, MI 48111
Phone: 734–699–1130
Fax: 734–699–1136
Email: admin@motilitysociety.org
Internet: www.motilitysociety.org
7 Dumping Syndrome
Association of Gastrointestinal Motility
Disorders, Inc.
12 Roberts Drive
Bedford, MA 01730
Phone: 781–275–1300
Fax: 781–275–1304
Email: digestive.motility@gmail.com
Internet: www.agmd-gimotility.org
International Foundation for Functional
Gastrointestinal Disorders
700 West Virginia Street, Suite 201
Milwaukee, WI 53204
Phone: 1–888–964–2001 or 414–964–1799
Fax: 414–964–7176
Email: iffgd@iffgd.org
Internet: www.iffgd.org
Acknowledgments
Publications produced by the Clearinghouse
are carefully reviewed by both NIDDK
scientists and outside experts. This
publication was reviewed by Thomas Ziegler,
M.D., Emory University Hospital.
You may also find additional information about this
topic by visiting MedlinePlus at www.medlineplus.gov.
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NIH Publication No. 13–4629

September 2013

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